Reassuringly calm? Self-reported patterns of responses to reassurance seeking in obsessive compulsive disorder

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Highlights

  • Although reassurance is a normal response, excessive reassurance seeking may maintain anxiety disorders.

  • Reassurance seeking was found to involve anxiety relief in the short term, returning in the long term; the net effect may assist day to day coping.

  • Reassurance may be best thought of as a super-check; that is, checking with an interpersonal boost.

  • Telling people to stop offering reassurance to those with OCD is mostly pointless and likely to be counter-productive.

Abstract

Background and objectives

The perception of threat and associated feelings of anxiety typically prompt people to seek safety; reassurance seeking is an interpersonal strategy almost universally used to reduce the immediate perception of risk. Excessive Reassurance Seeking (ERS) is considered to be particularly prominent and unequivocally counter-productive in people suffering from anxiety disorders in general and OCD in particular, producing short term relief but a longer term return and worsening of the original anxiety. We evaluated the extent and specificity of the effects of ERS in OCD and mechanisms involved in both anxiety relief and the hypothesized later return of anxiety..

Method

Self rated effects of reassurance seeking were investigated in 153 individuals with OCD, 50 with panic disorder, and 52 healthy controls, evaluating reactions to the provision and non-provision of reassurance.

Results

Reassurance is associated with short term relief then longer term return of both discomfort and the urge to seek further reassurance in both anxious groups; healthy controls do not experience significant resurgence. Greater return of anxiety and urge to seek more reassurance were associated with higher levels of overall reassurance seeking..

Limitations

The findings were based on retrospective self-report of naturally occurring episodes of ERS; prospective studies and induced behaviours are now needed.

Conclusions

Not only is reassurance a quick fix for people experiencing OCD, but in the absence of treatment the only fix! The findings explain why reassurance seeking continues despite advice that it will worsen anxiety problems. Such advice is potentially harmful to patients and their loved ones..

Section snippets

Self-report measures

Reassurance-Seeking Questionnaire (ReSQ: Kobori & Salkovskis, 2013). This questionnaire has four different scales and a separate section designed to assess emotional reactions.

  • 1.

    Probability: This section enquires how frequently participants seek reassurance, consisting of 22 items and five subscales: ‘Involving Other People in Reassurance’, ‘Professionals’, ‘Direct Seeking from People’, ‘Self-Reassurance’, and ‘External References’.

  • 2.

    Trust: This section is about how much participants trust a range

Overview

The main analysis is in two sections. Firstly, the perceived effectiveness of reassurance in terms of rated emotional reactions reported following reassurance seeking and good/unsatisfactory provision were analysed using a mixed model ANOVA in order to evaluate how each group of participants reported reacting when they were not able to obtain reassurance at all, and when they receive reassurance in the short-term and in the long-term.

Group comparison of ratings of effectiveness of reassurance and emotional changes

In the first comparison, the degree to which reassurance had

Discussion

The present study was conducted in order to characterise the reactions of people with OCD and make a comparison with both non-OCD anxious and healthy groups to situations involving the seeking and giving of reassurance. Three different situations were evaluated; immediately after the person from whom reassurance is sought provides it (short-term) and 20 min or more after they receive reassurance (long-term); the third comparison refers to when the person fails to offer reassurance (no

Conflict of interest statement

Neither author has any conflicts of interest to declare in relation to this work and manuscript.

References (15)

There are more references available in the full text version of this article.

Cited by (23)

  • Reassurance and its alternatives: Overview and cognitive behavioural conceptualisation

    2023, Journal of Obsessive-Compulsive and Related Disorders
  • Different cognitive behavioural processes underpinning reassurance seeking in depression and obsessive-compulsive disorder

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    Citation Excerpt :

    For this reason, many people will have experienced reassurance seeking as a helpful behaviour in their day to day lives (Salkovskis & Kobori, 2015). It is typically viewed as a helpful strategy for friends, family and health care professionals to offer reassurance when someone is anxious (Salkovskis & Kobori, 2015). However, recent research has implicated excessive reassurance-seeking (ERS) in perpetuating emotional distress and interpersonal difficulties (Halldorsson & Salkovskis, 2017; Parrish & Radomsky, 2010).

  • Online reassurance-seeking and relationships with obsessive-compulsive symptoms, shame, and fear of self

    2022, Journal of Obsessive-Compulsive and Related Disorders
    Citation Excerpt :

    Individuals with OCD have reported engaging in more frequent reassurance-seeking compared to those with anxiety disorders or depression (Haciomeroglu & Inozu, 2019; Morillo, Belloch, & García-Soriano, 2007). They have also reported stronger urges to seek reassurance and more persistent reassurance-seeking relative to other anxious groups, perhaps due to more rigid requirements (e.g., needing to seek reassurance until it feels “just right”; Haciomeroglu & Inozu, 2019; Kobori, Salkovskis, Read, Lounes, & Wong, 2012; Salkovskis & Kobori, 2015). The temporary relief associated with this strategy leads it to be used repeatedly and to play a role in maintaining obsessive-compulsive symptomatology.

  • Excessive reassurance seeking in depression versus obsessive-compulsive disorder: Cross-sectional and cognitive behavioural therapy treatment comparisons

    2020, Journal of Anxiety Disorders
    Citation Excerpt :

    Cross-sectionally, the severity of OCD symptoms has been significantly associated with higher levels of ERS (Orr, McCabe, McKinnon, Rector, & Ornstein, 2018; Starcevic et al., 2012). ERS may serve to strengthen the OCD symptom cycle by acting as a form of compulsive checking in response to anxiety related to intrusive thoughts and appraisals (Parrish & Radomsky, 2010; Rachman, 2002; Salkovskis and Kobori, 2015). While ERS has been hypothesized as an important maintenance factor in both depression (Evraire & Dozois, 2011) and OCD (Salkovskis, 1996), only in the latter has it been explicitly targeted for reduction.

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1

Now at Department of Psychology, University of Swansea, UK.

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